Diabetes Then and Now

Then…
I was diagnosed with Type 1 diabetes 23 years ago (I was 15 at the time). It was a total shock to my system, and, as anyone reading this blog will know, completely changed my life. Overnight, I was informed that I had a permanent, high-maintenance, irritating companion in life that would not leave my side even for a split second. His name was “Diabetes.” Yay.

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This was right before the advent of fast-acting insulins like Humalog and NovoLog, and my initial treatment plan was based on a set dosage every day of Regular and NPH insulin. All meals had to be timed to meet the peaks of this set regimen of insulin. Many of you reading this might remember those days. The meals had to have equal portions of carbohydrates, proteins, and fats. I might be able to switch out the SOURCES of said exchanges, but the grams had to be the same, every day. Basically, life had to revolve around my diabetes, not the other way around. It was a pain, but I adjusted and learned how to live by my meal schedule.

In the intervening years, potential cures have come and gone. It seems to me that there has ALWAYS been some kind of “promising research” that could “lead to a cure in a few years.” But none of these biological studies have yet yielded anything real. Lab mice have seen their diabetes reversed on occasion, but the leap to human trials has never taken place. But that doesn’t mean we haven’t made progress. We have. And things are just getting warmed up!

And now…
After 23 years living with MDI (multiple daily injections) and finger-stick testing, I am switching over to a CGM. (I’ve actually already been using actually the CGMfor about two months now and LOVE it. It’s not able to completely replace fingersticks — even with the recent FDA approval of the Dexcom G5 CGM for insulin dosing, the device still needs to be calibrated every 12 hours — and it’s not foolproof, but the overall accuracy has been surprisingly good, and having that trend graph is SO helpful for understanding how activities are really affecting my blood sugar!) And within the next month, I will be switching to an insulin pump. I have resisted the pump for years now. My A1Cs are generally very good, so I’ve been all right on MDI, but it seems that now is the time to switch.

It seems like the time because the first hybrid closed-loop system is actually FDA approved and set to hit the market in 2017 (the device has been mislabeled the first “artificial pancreas” by mainstream news sources — it’s not, it’s a pump that communicates with a CGM to automatically regulate basal, or background, insulin, but it is still largely user-input-driven). I have read articles and press releases by most of the other companies in the pump market, and it seems that just about everyone has a plan to release some version of a closed-loop system within the next three years. And within the next five to ten years, many in the industry are absolutely confident we will have a true “artificial pancreas.” These will be built around the integration of more and more accurate CGMs (Dexcom’s G6 sensors, set to be released in late 2017, have shown very strong results in clinical trials, achieving accuracy ratings within 8.9% of laboratory blood glucose testing, putting it almost on a par with fingerstick tests), and more and more advanced insulin pumps that can communicate with these CGMs and run highly advanced software that can predict trends and adjust to avoid the peaks and valleys we Diabetians have lived with for so many years.

And so, I take that leap into the world of insulin pumps, and join the chorus of Diabetians anxiously and hopefully awaiting the wonders of the next five years. For the first time in my life, I am actually hopeful that an (almost) cure may come. It won’t be a biological cure, and it won’t take away our condition. But as these closed-loop systems advance and close the gap between “closed-loop hybrid pump” and a truly self-automating “artificial pancreas,” the lives of those of us living with this disease will be transformed in the most profound way.

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